Barriers to timely antibiotic delivery and associated interventions
| Findings from failure mode effects analysis | LOR 2 interventions | Number of PDSA cycles | |
|---|---|---|---|
| Pre-arrival interventions location: ED PDSA cycle timing: July 2010 to June 2011 | Referral information relayed to one attending | Standardised referral made to ED physician, charge RN and clerical staff | 4 |
| Variable information collected and delivered at time of referral | EMR-based referral checklist with pre-populated patient specific information with a smart phrase and link | 6 | |
| Intermittent communication amongst ED staff | Pre-arrival team huddle | 5 | |
| Orders completed after patient's ED evaluation | Standardised order set completed at time of referral (labs and antibiotics) | 3 | |
| Post-arrival interventions location: ED PDSA cycle timing: July 2011 to November 2011 | Variable awareness of patient arrival to ED | Standardised arrival process | 3 |
| Lack of a standard team approach to patient evaluation and antibiotic administration | Standardised room-to-antibiotic administration process | 3 | |
| Clinical-specific interventions location: clinic PDSA cycle timing: March 2011 to July 2011 | Variable awareness of the amount of time F&I patients had been in the clinic prior to antibiotic administration | Use of a 60 min countdown timer for all F&I patients | 3 |
| Unreliable identification of F&I patients prior to arrival in the clinic | Standardised process of identification of F&I patients prior to arrival in the clinic | 2 | |
| Delayed antibiotic administration secondary to delayed registration | Standardised prompt registration process for F&I patients | 2 | |
| Sustaining of interventions location: ED/clinic timing: December 2011 to January 2015 | Variation in education modalities for vascular access and F&I process | Standardised education module for all ED and clinic staff including interval refresher courses | 3 |
| Variable awareness of process amongst staff and leadership | Posting of updated run-charts for staff and monthly review of F&I results on ED/CBDI dashboards | 2 | |
| Variable understanding of Failures | Rapid analysis of all failures | 1 | |
| Delay in port access secondary to delayed application of EMLA cream on the port site | Standardised process to review EMLA cream availability at home upon hospital discharge and during clinic visits | 1 | |
| Enhancing sustainability location: ED timing: 9/14–1/15 | Delayed port access | Implementation of the rapid response team, which included a vascular access team member | 2 |
CBDI, Cancer and Blood Disease Institute; ED, emergency department; EMLA, eutectic mixture of local anaesthetics lidocaine/prilocaine; EMR, electronic medical record; F&I, febrile immunocompromised; LOR, level of reliability; PDSA, Plan-Do-Study-Act.